3008 BUTLER ST 2018-05-14 - Laserfiche WebLink

1 �, � � � �� v�r��r�� i s�rn►�� u�ri�i�� P��.icA-riorv � � - CITY OF EVERETT PERMIT SERVICES � 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 � FAX 425-257-8857 � (E) everetteps@evereftwa.gov � www.everetiwa.gov/permits : " ��;�� ^r�,��..�P�ROJECT�SI�E M1INFORMA710N ; ? RROJECT ADDRESS: " Q� IF APPL(CABLE: ❑OUTSIDE GITY LIMITS 0 BUILQING AREA SF ❑ LOT# BUILDING TYPE: ❑SFR-DETACHED ❑SFR ATTACHED �DULEX ❑MULTI-FAMILY�OF UN(TS; ❑COMMERCIAL ❑INDUSTRIAL GHANGE OF USE? N� ❑YES, FROM TO �` �� ` 'ry ': ,_ ; UTILITY APPLICATION 1NFORMATION f ' ` ,,, �. :q a �� SEWER(check all that appiy) WA7ER(check all fhat apply) ❑SIDE SEWER REPAIR ❑ NEW WATER SERVICE WSTALLATION ❑SIDE SEWER ALTERATION ❑COMPLETE SERVICE ❑METER ONLY ❑ NE1N SIDE SEWER INSTALLATION � SERVECE/METER USE: �INSTALL BACKWATER VALVE oufside#he buitding) ❑SFR ❑SIDE SEWER CAP-OFF ❑ MULTI-FAMILY-#OF UNITS: ❑SIDE SEWER RECONNECTION ❑COMMERCIAL MULTIPLE DOMESTIC"WATER SERVICES REQUEST WATER SERVICE TYPE/SIZE:(circle desired size) � I AM DECLINING MULTfPLE DOMESTIC WATER SERVICES FOR ' ❑DOMESTIC: 374", '1", 2", OTHER: MY MULTI-FAMfLY DEVELOPMENT UNDER SINGLE OWNERSHIP, ❑ IRRIGATION: 314'; 1", 2", OTHER: ❑ I AM OPTING TO INSTALL MULTIPLE DOMESTIC WATER ❑FIRE: 1", 2", 4", 6", ` 8", OTHER: SERVICES FOR MY MULTI-FAMILY DEVELOPMENT UNDER ❑ DOMESTIC/FIRE COMBO: 1", 2", OTHER: SINGLE OWNERSHIP. FILL OUT REVERSE SIDE OF THIS FORM, CQ:NTACT INFORMATION OWNER NAME: TENANT NAME(If Commercial): OWNER MAILING ADDRESS: srReeT CITY STATE ZIP OWNER PNONE: OWNER EMAIL: CONTRACTOR NAME: CONTRACTOR AbDRESS: srReEr . I � CITY STATE � • ZIP , • GONTRACTOR PHONE: � CO TRAC70R EMAIL: � CONTRACTOR LIC.#(REC�UIRED). : CI'fY OF EVERETT BUSIN LIC.#{REQUIRED): D PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: � CONTACT PHONE: � (,t 5�b Z �Y�I�j �G�,� Y�;'�� CONTACT EMAIL: � � C � t AGREEMENT.�The undersigned app/icant agrees to comp/y with a/!provisions of the Evereft Municipa/ de Tit/e Cify of Ever t Offcial Use Only 94 INater and Sewer or such otherrules and regulations now existing or which may be established from time to FEE, fime.The applicant fu�ther agrees, a con i' precedent to receiving service that the ufilities division shall have f�,�.�O,p� the righf at any ' e,w' f notic,to shut off o turn on the water supply forrepai�s,construction,and l�{� w nonpayment ch s or or an other reasona le cause.1 am the owner,or 1 am authorized by the owner of this �� oroperty to p' or he wo hich applicatio is made,and 1 complywith the State Contractors Law 18.27 PERMIT# RCW and 29 Z00 WAC � 1�,D2' 00 5� wner/Authoriz gent Sig fure Date (Revised 90/12/2095)